Alzheimer Center, Postbus 7057, 1007 MB, Amsterdam, The Netherlands.
Alzheimer Center, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands.
J Clin Psychiatry. 2020 Feb 4;81(1):19m12811. doi: 10.4088/JCP.19m12811.
To investigate which neuropsychological tests can discriminate between behavioral variant frontotemporal dementia (bvFTD) and psychiatric disorders presenting with similar late-onset frontal behavioral changes, such as apathy, disinhibition, reduced empathy, or compulsive behavior.
Patients presenting with frontal behavioral changes in middle or late adulthood received extensive baseline examinations, including neuropsychological assessment and brain imaging. After 2 years, examinations were repeated and patients were diagnosed according to DSM-IV or international bvFTD consensus criteria. The study period was April 2011-June 2015. Two groups were selected: 32 patients with bvFTD and 53 patients with a psychiatric or psychological diagnosis. Associations between neuropsychological test scores and diagnostic group were investigated with logistic regression analyses, and diagnostic accuracy was investigated with a receiver operating characteristic curve.
BvFTD patients scored lower on tests for confrontational naming, gestalt completion, and verbal abstraction compared to psychiatric patients (P < .01). The confrontational naming test (Boston Naming Test) showed the strongest association with diagnostic group: a lower score indicated a higher probability for a bvFTD diagnosis (P < .001). This test could discriminate between the groups with good diagnostic accuracy (area under the curve = 0.81). Tests for attention, memory, and executive functions showed no discriminative ability between the groups.
Although one of the criteria of bvFTD is low performance on executive tests, these tests are not useful in differentiating bvFTD from psychiatric disorders. We recommend administering language tests, especially an extensive confrontational naming test, to aid differentiation between bvFTD and a psychiatric disorder in patients presenting with late-onset frontal behavioral changes.
探究哪些神经心理学测试可以区分行为变异额颞叶痴呆（bvFTD）和以类似的晚发性额部行为改变为特征的精神障碍，如淡漠、抑制减退、同理心降低或强迫行为。
中年或晚年出现额部行为改变的患者接受了广泛的基线检查，包括神经心理学评估和脑成像。2 年后，再次进行检查，并根据 DSM-IV 或国际 bvFTD 共识标准进行诊断。研究期间为 2011 年 4 月至 2015 年 6 月。选择了两组患者：32 名 bvFTD 患者和 53 名精神科或心理科诊断患者。使用逻辑回归分析调查神经心理学测试分数与诊断组之间的关联，并使用接收者操作特征曲线调查诊断准确性。
与精神科患者相比，bvFTD 患者在命名测试（波士顿命名测试）、完形填空测试和言语抽象测试中的得分较低（P<.01）。命名测试（波士顿命名测试）与诊断组的关联最强：得分越低，bvFTD 诊断的可能性越高（P<.001）。该测试对两组具有良好的诊断准确性（曲线下面积=0.81）。注意力、记忆和执行功能测试在两组之间没有区分能力。
尽管 bvFTD 的标准之一是执行测试表现不佳，但这些测试对于区分 bvFTD 和精神障碍没有帮助。我们建议对语言测试，尤其是广泛的命名测试进行评估，以帮助区分以晚发性额部行为改变为特征的 bvFTD 和精神障碍。
